JOB DESCRIPTION:
Provider Network Manager manages the operations of the Celestial services provider network. Responsible for establishing and maintaining processes and systems to provide routine services to members including contract management and credentialing. Being a Provider Network Manager recruits, hires, trains, and measures performance of staff and/or contractors to provide effective and reliable operations within budget(s).
May be involved with the design and operations of database systems used to manage provider data and produce reports and analysis. Additionally, Provider Network Manager requires previous experience. Typically reports to top management. The Provider Network Manager typically manages through subordinate managers/contractors and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Provider Network Manager typically requires 3+ years of managerial experience.
Build and manage high-performing provider networks using a holistic, coordinated approach. Drive provider engagement through performance and service. Responsible for vendor management with a centralized interface. Point-of-Care Interface. Provider Engagement Hub. Provider Data & Analytics. Management of the operations of Celestial Services provider network. Responsible for establishing and maintaining processes and systems to provide routine services.
Responsibilities May Include:
- Maintaining relationships with in-network services providers, facilitators and members.
- Updating personalized wellness plans for members.
- Collaborating with members' families, friends, and social supports in developing wellness/treatment plans.
- Identifying and recruiting high-quality network providers and facilitators.
- Interacting with healthcare providers to facilitate members' treatments.
- Ensuring members’ treatment requirements are met.
- Suggesting alternative treatment plans when members' services requests do not meet medical necessity criteria.
- Instructing and educating members on procedures, vendor/provider/facilitator instructions, and referrals.
- Linking members to social services programs and entitlements such as transportation assistance and translation services.
- Conducting regular follow-ups with members to evaluate progress, promote continuity of care, and ensure improved health outcomes.
- Maintaining records of case management activities.
